Background: Heterotopic pregnancy is a rare event that usually presents in the first 6-8 weeks of pregnancy.
Case: A 35-year-old primigravida was referred to the hospital at 18+ weeks' gestational age for evaluation of chronic abdominal pain. Ultrasound revealed a heterotopic pregnancy. The patient underwent surgery for removal of the ectopic pregnancy.
Conclusion: Heterotopic pregnancy can present at any time during pregnancy and should be considered in any pregnant woman with abdominal pain.